Primary Care Treatment for Overweight Adolescent Females

描述(申请人提供)：在过去的二十年里，青少年超重或肥胖的比例几乎增加了两倍，从5.5%增加到14%。虽然相当多的研究集中在成人体重控制上，而且越来越多的研究检查儿童肥胖，但针对青少年的治疗方法还没有得到充分的研究。我们将研究以初级保健为基础的多成分生活方式干预对超重青少年女性及其家庭的临床疗效和增量成本效益。参与者将是250名年龄在13岁至15岁之间的女性，体重指数(公斤/平方米)在2000年国家标准的第95至第99百分位数之间。参与者将被随机分配到多组分的、基于行为的体重控制干预或常规护理控制条件下。干预措施将根据性别和发育阶段量身定做，并将包括协调反馈和青少年儿科医生持续的咨询。此外，干预将包括青少年小组会议，家长小组会议，以及与辅导员的后续电话联系。这项试验考察了改变生活方式(饮食和活动的变化)对体重和相关发病率的影响，重点是能量平衡。我们干预的活动部分包括一个以瑜伽为基础的组成部分，以一种对超重青少年没有威胁的方式促进身体意识。随机化后6个月、12个月和24个月将对所有参与者进行后续数据收集。主要的结果衡量标准将是BMI z得分的变化。次要结果包括体力活动、饮食摄入量、抑郁、饮食紊乱、选定的生理和心理指标以及医疗保健使用费用的变化。这项应用为现有的青少年肥胖研究提供了以下新的进展：a)干预措施是针对青春期女性的特定需求进行的，b)它扩展了干预的范围，在适当的情况下包括对情绪调节和饮食紊乱的关注，c)这一多个组成部分包括儿科医生、小组会议和个人电话联系，d)它充分利用了综合健康计划中初级保健环境的独特特征，以及d)儿科医生长期参与干预，与慢性病护理模式保持一致

DESCRIPTION (provided by applicant): In the past two decades, the percentage of adolescents who are overweight or obese has almost tripled, from 5.to 14%. Although considerable research has focused on adult-weight control, and a growing body of research examines childhood obesity, treatments for adolescents have not been adequately studied. We will examine the clinical efficacy and incremental cost-effectiveness of a primary care-based, multi-component lifestyle intervention for overweight adolescent females and their families. Participants will be 250 females aged 13-15 with a body mass index (kg/m2) between the 95th and 99th percentile for the year 2000 national norms. Participants will be randomly assigned to a multi-component, behaviorally-based, weight control intervention or a usual care control condition. The intervention will be tailored for gender and developmental stage, and will include coordinated feedback and ongoing counseling from the adolescent's pediatrician. In addition, the intervention will include group meetings for teens, group meetings for parents, and follow-up telephone contacts with counselors. The trial examines the impact of lifestyle modification (changes in eating and activity) on weight and associated morbidity, with an emphasis on energy balance. The activity portion of our intervention includes a yoga-based component to promote body awareness in a no threatening manner for overweight adolescents. Follow-up data collection for all participants will be conducted at 6, 12, and 24 months following randomization. The primary outcome measure will be change in BMI z scores. Secondary outcomes include changes in physical activity, dietary intake, depression, disordered eating, selected physiological and psychological measures, and cost of medical care utilization. This application provides the following novel advances of existing youth obesity research: a) the intervention is developmentally adapted for the specific needs of adolescent females, b) it extends the reach of the intervention to include a focus on mood regulation and disordered eating, where appropriate, c) this multi-component includes pediatricians, group meetings, and individual telephone contacts, d) it fully utilizes the unique features of a primary care setting in an integrated health plan, and d) the pediatrician has an enduring involvement in the intervention, consistent with the chronic disease model of care